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Wednesday, December 1, 2010

Finally, Some Sanity

Normally TSB doesn't spend much time applauding some of the comments that are made on this blog spot. But I must admit, there actually is someone amongst us that brings us some sanity by the commentary that they provided us. If anything, this individual should be applauded. Please take the time out to read this and rather than provide us with a knee-jerk reaction take the time to think about the truth that echoes in these words.

"I have seen some of the most extreme intellectual hypocrisy among us at the meetings in the U.S. lately.I could literally write a list of 100 things...but the top has to beTo hear most of "us" talk, Medicare should simultaneously be discontinued and have its budget tripled.Private insurance companies need to listen to the "Government" when it approves something...The "Government" needs to listen to private companies to decide what to approve...We want FDA to approve what we tell them to approve, but we want FDA approval to shield us from liability.We file patents for unique inventions and 510(k)'s for Me-too copies; of the same exact drawing.Its actually quite hilarious to listen to people argue with themselves sometimes."

TSB, that is truly a very intelligently put set of examples of the contradictions in our field, and worth pointing out. But keep in mind, it's not necessarily the same person expressing the contradictions. Yes, there are those of us lacking the reason to recognize the contractions in our own minds, but more likely it's simply a reflection of the variation in the viewpoints that exist in our community. As with most things, if it was that easy, it would be done. And there wouldn't be such contradictions if there weren't two contradictory sides worth believing. Or do I give "us" too much credit?

Looking back at the post that inspired the above list of contradictions, perhaps it's worth mentioning to anyone that thinks that the health care "provider" sector (including docs, facilities, industry, etc.) are under fire from the feds, well "we ain't seen nothin' yet.". Right now much of the focus of health care reform is on the insurance side of the equation, which is fine because there are plenty of fixes to make. But the provider side will start taking way bigger cost-cutting hits in the future. Once the insurance side has taken its blows, they'll say "hey Mr. President, we've cut our gross margins below 20% like you asked, we've taken up the uninsured, we've made our marketplace more competitive, but now the main reason premiums are so high is that our expenditures to the provider side are simply too high". That's when the real hammers will come down on us. Much like a CEO taking on a dysfunctional company, first changing what everyone is complaining about, then they turn their attention to the complainers. The insurers are getting theirs, we'll get ours too. What we're seeing now is only the beginning.

Power is in organization, numbers and capital. Just look at the behavior that the industry has exhibited over the last year. Docs complains about sales reps earnings, that's like complaining that federal employees are contributing to the deficit, executive management complains that salespeople can't sell "me-too" products with incomplete portfolios, POD's are increasing by the day. We can unite and fight or allow ourselves to defeat and conquer ourselves. You make the choice, I have made mine. Oh and by the way, this isn't about preserving what salespeople have, because once you get rid of us, they will only come after you. Think about it.

insurance co's should compete nationwide. healthcare will never rebound until the business parameters are clearly defined. obamacare hemmorhages cash in typical liberal fashion all the while ignoring common sense solutions that do not require expenditures.

Who making the right call on the intensity of insurers pushing back on spinal procedures? This was written in WSJ...While NuVasive lowered guidance twice within a short span and called out more severe pushback from insurers, Medtronic has had a different perspective. The company reported results last week for a fiscal quarter that ran through October while saying it has seen stability in the overall market following a dip this summer. While Medtronic's spinal business is much bigger than NuVasive, and the companies have many differences in terms of products and market areas they serve, Medtronic's CEO has disagreed with NuVasive's views on more aggressive insurer pushback. "I don't know what compelled them to be so dramatic," Hawkins said in a recent interview.

NuVasive's Lukianov said Wednesday that Medtronic is off base, and had some pointed comments of his own. "I don't know where they get their information from," Lukianov said. "We get ours directly from the field. We're not a division of a division of a division."

4:48,, Appreciate the recap of the Nuvasive call yesterday,, Funny that Lukianov said Medtronic is off base, since he LONGS to become what Medtronic IS. Also funny that he takes several shots at them as he & his team continue to reach for any excuse possible to help explain/ justify their failure to execute and deliver results in the most recent qtr.Bottom line is that Nuvasive continues to see some of its top people depart and continues to fail to want to look at & recognize its own short comings as a company. The insurance companies have always pushed back on new technologies,, whether it be pedicle screws, BAK cages, kyphoplasty, TDRs, etc,, it's just easier now to place the blame on them when failing to appease the boys on Wall St.

"Finally some sanity?Thanks for pointing out that people have differing opinions. "

No, pointing out that for many of YOU/US in this industry in the US right now our bread and butter depends on a set of contradictory and often opposing views existing in the SAME PERSON.

Avett Bros.Head Full Of Doubt/Road Full Of Promise:

"There’s a darkness upon me that’s flooded in lightIn the fine print they tell me what’s wrong and what’s rightAnd it comes in black and it comes in whiteAnd I’m frightened by those that don’t see it

When nothing is owed or deserved or expectedAnd your life doesn’t change by the man that’s electedIf you’re loved by someone, you’re never rejectedDecide what to be and go be it

There was a dream and one day I could see itLike a bird in a cage I broke in and demanded that somebody free itAnd there was a kid with a head full of doubtSo I’ll scream til I die and the last of those bad thoughts are finally out

There’s a darkness upon you that’s flooded in lightAnd in the fine print they tell you what’s wrong and what’s rightAnd it flies by day and it flies by nightAnd I’m frightened by those that don’t see it

There was a dream and one day I could see itLike a bird in a cage I broke in and demanded that somebody free itAnd there was a kid with a head full of doubtSo I’ll scream til I die and the last of those bad thoughts are finally out

There was a dream and one day I could see itLike a bird in a cage I broke in and demanded that somebody free itAnd there was a kid with a head full of doubtSo I’ll scream til I die and the last of those bad thoughts are finally out

There’s a darkness upon me that’s flooded in lightIn the fine print they tell me what’s wrong and what’s rightThere’s a darkness upon me that’s flooded in lightAnd I’m frightened by those that don’t see it"

Think of any spine surgeon you have met that complains that all the data is out there on artificial discs and that the insurance companies need to cover them.

That person is basically saying that private businesses need to heed some external pressure.

Why? In any other context in our society that same person, often wealthy and politically conservative, and often the type to refer to our recent Health Care Reform Act as "Obamacare", would call such intervention into a private businesse's affairs as "Socialism" or worse...and yet, they want someone to tell these insurance companies what to pay for and how much.

Yes, that coalign thing certainly looks genius! No failure mechanisms to worry about with that design. Besides, everyone knows that filling an interbody device with bone graft from endplate to endplate is a bunch of Hooey...

Hey TSB, not to digress from this sharply focused posting, but following up on a string from the late November post, how about a topic with the following question to your audience:

Which statement more accurately reflects the performance of the FDA and why?

1. The FDA's contributions in encouraging and mandating advancements in the validation of safety and efficacy of spinal products clearly outweigh any negative effects that may result from discouragement of innovation or lack of competition.

or

2. The negative impact from FDA's discouragement of innovation and prevention of competition through their regulatory practices clearly outweigh any beneficial effects that may result from their encouraging and mandating advancements in the validation of safety and efficacy of spinal products.

That study is crap. Of course device manufacturers are going to feel burdened by rules; that's been true since even before the first breast implant leaked. All that study did was give them a forum to bitch about it.

The company that learns to navigate the current US regulatory landscape will gain a serious competitive advantage in the US market. The company that focuses their efforts on moaning about it will move all operations to Europe.

"Just three years later, in 1995, Dow Corning Corp., once the major manufacturer of silicone breast and other implants, faced 19,000 lawsuits, pushing it into bankruptcy."

"Since the early 1990s, a number of independent systemic comprehensive reviews have examined studies concerning links between silicone gel breast implants and systemic diseases. The consensus of these reviews is that there is no evidence of a causal link between the implantation of silicone breast implants and systemic disease."

"Currently the FDA has approved silicone gel-filled breast implants and over a million women around the world have already received these implants. Breast implants and breast augmentation surgery is now commonplace all over the world."